The invention generally involves urethral prostheses and related methods for draining bodily fluid from a patient.
Normal voiding of urine can be controlled through a patient""s sphincter muscles, including voluntary control through the external sphincter. When functions of sphincter muscles are temporarily compromised, for example, due to anesthesia, a patient""s control over normal urine voiding is likewise temporarily compromised.
Medical professionals that treat patients undergoing an anesthetic procedure currently have limited options for addressing urinary retention during and after the procedure. These include the use of a Foley catheter. In many cases, because post-operation assistance in voiding is needed (such as in the case of a urethral stenosis), the Foley catheter will remain in the patient""s urethra. However, there are disadvantages in the use of a Foley catheter after an anesthetic procedure. For example, because the Foley catheter provides constant drainage through the urethra by maintaining the internal sphincter open, it does not allow the patient to control voiding even after the patient recovers normal sphincter function. This has brought inconvenience and emotional distress to the patient. Also, the Foley catheter extends outside the body, again causing the patient emotional distress and discomfort. The extracorporeal portion of the Foley catheter also subjects the patient to risks of infection.
It is an object of the invention to provide a patient (e.g., a human male) with assisted urinary voiding, while also allowing the patient to control the external sphincter muscle as it regains functionality, such as after an anesthetic procedure. It is another object of the invention to provide the patient with such assisted and controllable release without the discomfort, emotional distress, or infection rates associated with conventional treatments.
In one aspect, the invention relates to a urethral prosthesis capable of adopting at least two configurations depending on the functioning or non-functioning of a patient""s external sphincter muscles. When the external sphincter muscles are not functioning or malfunctioning, the prosthesis may assume a compact configuration (locked or tied), and be placed in the urethra and adjacent the external sphincter muscles to provide constant drainage. When the external sphincter regains its function, the prosthesis may be transformed into an extended configuration. Reconfiguration will allow reposition of portions of the prosthesis away from the external sphincter muscles so that the muscles can contract and control urinary voiding.
An embodiment in accordance with these aspects of the invention includes a first segment, a second segment, and an adjustable tie connecting the two segments. The first segment includes a distal portion with at least one distal opening for receiving fluids such as urine, and a proximal portion with at least one proximal opening. A lumen extends from the at least one distal opening to the at least one proximal opening. The second segment similarly includes a distal portion, a proximal portion, and a lumen extending from at least one distal opening to at least one proximal opening. The connecting tie is adjustable with a variety of inter-segmental lengths; such adjustments result in a variety of corresponding distances between the segments. The tie may be adjusted to shorten the distance between the segments so that the proximal portion of the first segment directly contacts the distal portion of the second segment. This xe2x80x9ccompactxe2x80x9d configuration of the prosthesis is useful when patient""s external sphincter is malfunctioning because the sphincter muscles may be held open by the prosthesis, resulting in constant drainage. When the external sphincter regains its function and voluntary control over the assisted voiding is desired, the prosthesis can be adjusted to assume an xe2x80x9cextendedxe2x80x9d configuration. To do so, the inter-segmental distance is lengthened to allow insertion of an object, such as a portion of the external sphincter, which intercepts fluid communication between the lumens of the two segments. Under this extended configuration, the prosthesis permits functional sphincter muscles to contract and block, or extend and open fluid communication between the lumens, and therefore, achieving voluntary control over assisted urine voiding.
The adjustable tie in this embodiment may comprise a thread with two-ends. The ends may be connected or unconnected. In a preferred embodiment, the thread forms at least one loop between the proximal portion of the first segment and the distal portion of the second segment. In a particularly preferred embodiment, the thread forms a one-and-a half loop between the segments. The ends of the thread may be knotted together. Upon pulling the knot in a substantially proximal direction, the tie tightens the connection between the two segments, i.e., it shortens the inter-segmental distance.
The prosthesis, in accordance with another aspect of the invention, may further include a second tie connecting the proximal portion of the first segment and the distal portion of the second segment. This second tie has a pre-determined inter-segmental length between the first and the second segments of the prosthesis. The pre-determined inter-segmental length in turn sets the maximum value for the distance between the first and the second segments of the prosthesis. Such a maximum inter-segmental distance may be sufficient for the insertion of at least a portion of the functional external sphincter to effect voluntary control over fluid drainage. To reach this maximum inter-segmental distance, a retrieval piece may be connected to the proximal portion of the second segment. This retrieval piece may be a thread that can be pulled upon to help adjust the distance between the prosthetic segments, e.g., by pulling substantially away from the first prosthetic segment. Furthermore, a third segment may be removably connected to the proximal portion of the second segment. The third segment includes a distal portion, a proximal portion, and a lumen extending from at least one distal opening to at least one proximal opening. Fluid flowing from the lumens of the first and second segment can be relayed through the lumen of the third segment and emptied into a drainage bag connected to the proximal portion of the third segment.
An embodiment according to another aspect of the invention includes a first and a second segments similar to the ones described above. At least two ties connect the segments. The first tie engages the two segments by holding the two segments close enough to allow fluid communication between the lumens of the segments. In a preferred embodiment, the first tie holds the proximal portion of the first segment in direct contact with the distal portion of the second segment. The second tie connects the two prosthetic segments together at an inter-segmental distance upon disengagement of the first tie. This inter-segmental distance may be long enough to permit bodily control of fluid communication between the tubular lumens (e.g., insertion of portions of a sphincter muscle). Again, a retrieval piece may be connected to the proximal portion of the second segment. This retrieval piece may be a thread that can be pulled upon to help increase the distance between the prosthetic segments. Furthermore, a third segment with a lumen may be removably connected to the proximal portion of the second segment. Again, fluid flowing from the lumens of the first and second segment can be relayed through the lumen of the third segment and emptied into a further connected drainage bag.
Embodiments of the invention may include additional features. For instance, the first segment may incorporate an inflatable balloon. The balloon may be used for proper placement of the prosthesis. The distal portion of the first segment may further comprise a coudxc3xa9 tip. The first and second tubular segments are preferably made of a biocompatible material, such as silicone.
A method is provided for draining bodily fluid from a patient. A prosthesis having two connected segments is inserted into the urethra of a patient, then the distance between the segments is adjusted in response to sphincter functionality. When the patient has temporarily lost his sphincter function, the distance between the two segments may be shortened to allow fluid communication between the lumens of the prosthetic segments. When the patient regains sphincter function, the two segments of the prosthesis can be adjusted further apart to allow the sphincter muscles to come in between the two segments. A prosthesis with an adjustable tie as described above is useful for these purposes. The prosthesis may include a retrieval piece connected to the second segment. Pulling the retrieval piece substantially away from the first segment may help lengthen the inter-segmental distance, while pulling both ends of the adjustable tie shortens the inter-segmental distance. Furthermore, a second tie may be also provided to connect the proximal portion of the first segment with the distal portion of the second segment. The second tie connects the two segments at a distance from each other, limited by a pre-determined length. This pre-determined inter-segmental distance may be long enough to allow the patient""s sphincter muscles to come in between the two segments and control voiding.
Another method is provided for draining bodily fluid from a patient. A prosthesis having two segments is inserted into the urethra of a patient, and the two segments are connected by at least two ties. The first tie engages the two segments by holding the two segments close enough to allow fluid communication between the lumens of the segments. The second tie has a longer inter-segmental length. When the first tie is engaged, constant drainage is provided. However, when sphincter control over urine voiding is desired, the first tie is disengaged from the prosthesis and/or removed from the urethra while at least a portion of the prosthesis remains in the urethra. And the second segment may be pulled away from the first segment through a retrieval piece attached to the second segment, increasing the inter-segmental distance. Because the first tie is disengaged, only the second tie is holding the tubular segments together, and its inter-segmental length determines the distance between the prosthetic segments. This distance may be long enough for the sphincter muscles to assert control over fluid communication between the lumens.
The foregoing and other objects, aspects, features, and advantages of the invention will become more apparent from the following description including drawings and from the claims.